Ask the payment expert ... about the financial benefits of QAPI

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Ask the payment expert ... about the observation stay loophole
Ask the payment expert ... about the observation stay loophole

What are the financial benefits to implementing CMS's Quality Assurance Performance Improvement program? 

You are probably doing many pieces of the QAPI program now in your facility, so it shouldn't be too hard to implement the process CMS is describing. The biggest differences in this program are changes in terminology and the steps of implementation.   

Your quality measures remain a prime tool to show areas that might need improvement. Let's say your percentile ranking for short stay pain is increasing. You can do a root cause analysis to determine the cause of this increase. You can brainstorm with a team of staff to identify all the factors that could be contributing to that problem. This way you are not just assuming what the cause is, such as assuming all post-surgical residents have pain. There are many factors that could be affecting residents, and many ways to relieve their pain. 

You might discover through the QAPI process that your mattresses are not the most comfortable, that your staff is not asking residents what their pain ranking is each time they interact (and then your residents are waiting longer for pain meds), or that you haven't investigated what the resident's non-pharmaceutical interventions are that provide pain relief.  

You could also find that the MDS is not being coded correctly. This simplifies the process, but you can fit this into QAPI by doing root cause analysis, chartering a Performance Improvement Project team and tracking your results and ongoing monitoring. 

So how can QAPI affect your financial outcomes? By improving your consumer satisfaction, in turn improving census; by decreasing survey deficiencies and thereby decreasing or eliminating Civil Money Penalties.  


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